Personal Data Form

Name *

First

Last

Email Address *

Emergency Contact

Name *

First

Last

Relationship *

Home Phone Number *

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Work Phone Number

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Cell Phone Number

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Public Relations

Notre Dame of Maryland University has the right to the use and reproduction of photographs taken of students while enrolled at the University for current and future use in University publications and marketing efforts. Those students who do not wish to have their photographs used in publications must submit a signed statement to the registrar’s office before the first Friday of each semester.

Would you like for us to share your personal achievements and accolades with your local, hometown media? *

Yes

No

If yes, please provide the name of your hometown newspaper

Would you like for us to share your personal achievements and accolades with designated family members or friends?